Tosun Fuat, Ozer Cem, Gerek Mustafa, Yetiser Sertac
Department of Otorhinolaryngology and Head Neck Surgery, Gülhane Military Medical School, Etlik, Ankara, Turkey.
J Craniofac Surg. 2006 Jan;17(1):15-20. doi: 10.1097/01.scs.0000193555.24670.4c.
This study presents a comparative analysis of current surgical approaches for the treatment of nasopharyngeal angiofibroma, including extension of tumors, postoperative morbidity, complications, and recurrence rate. Twenty-four patients who underwent surgery with the diagnosis of juvenile nasopharyngeal angiofibroma at our department between 1993 and 2003 were retrospectively reviewed according to their clinical presentation, surgical approaches, and prognosis. Radkowski staging scale was used for staging tumors. The transpalatal approach was used in 10 patients before 1999 with tumor stages between Ia and IIa. Transpalatal fistula was encountered in one. Nine patients underwent transnasal endoscopic surgery after 1999 with tumor stages between Ia and IIIa. Lateral rhinotomy in four patients and a degloving approach in one patient were used with tumor stages between IIa and IIIa; postoperative nasal crusting was the most annoying problem in these groups. Recurrent tumor was seen in only one patient who had undergone the transpalatal approach in the 12- to 56-month follow-up period. In this regard, the transnasal endoscopic approach can be used successfully in place of the transpalatal approach due to the former's lesser surgical morbidity and wide lateral exposure of the field in patients with nasopharyngeal angiofibroma. Also, many patients who underwent lateral rhinotomy for the removal of stage IIa, IIb, and IIIa tumors can successfully be treated using the transnasal endoscopic approach. In tumors that extend, infratemporal fossa lateral rhinotomy and degloving approaches provide the optimal exposure but have higher potential for morbidity than does transnasal endoscopic surgery.
本研究对目前治疗鼻咽血管纤维瘤的手术方法进行了比较分析，内容包括肿瘤的扩展情况、术后发病率、并发症及复发率。回顾性分析了1993年至2003年间在我科诊断为青少年鼻咽血管纤维瘤并接受手术治疗的24例患者的临床表现、手术方法及预后情况。采用Radkowski分期量表对肿瘤进行分期。1999年前，10例肿瘤分期为Ia至IIa期的患者采用经腭入路，其中1例出现腭瘘。1999年后，9例肿瘤分期为Ia至IIIa期的患者接受了鼻内镜手术。4例肿瘤分期为IIa至IIIa期的患者采用外侧鼻切开术，1例采用掀翻术；这些组中术后鼻痂形成是最恼人的问题。在12至56个月的随访期内，仅1例接受经腭入路手术的患者出现肿瘤复发。在这方面，鼻内镜入路由于手术创伤较小且能广泛暴露术野，可成功替代经腭入路用于治疗鼻咽血管纤维瘤患者。此外，许多因切除IIa、IIb和IIIa期肿瘤而接受外侧鼻切开术的患者，也可通过鼻内镜入路成功治疗。对于侵犯颞下窝的肿瘤，外侧鼻切开术和掀翻术能提供最佳暴露，但比鼻内镜手术的发病风险更高。
